AIDS A NEW DISEASE'S DEADLY ODYSSEY

Robin Marantz Henig is the author of ''Your Premature Baby,'' to be published in the spring.

Medical detectives are calling it the century's most virulent epidemic. It is as relentless as leukemia, as contagious as hepatitis, and its cause has eluded researchers for more than two years. Acquired immune deficiency syndrome, or AIDS, was first seen in homosexual men - particularly those who were promiscuous - but it has now struck so many different groups that its course cannot be predicted.

And despite a massive nationwide microbe hunt involving hundreds of investigators and millions of dollars, scientists simply cannot catch up with it. ''We're always a few steps behind,'' says Dr. William W. Darrow, a research sociologist with the Centers for Disease Control (C.D.C.) in Atlanta, ''and that makes us very, very concerned. The disease could be anywhere now.''

While AIDS has continued to rage in big-city homosexual communities with terrifying and deadly results, it has also struck Haitian men and women, intravenous-drug users, female partners of drug users, and infants and children. AIDS has become the second leading cause of death - after uncontrollable bleeding - in hemophiliacs, and, most recently, a number of surgical patients who have received blood transfusions have contracted AIDS, raising fears among some observers about the nation's blood supply.

The mysterious AIDS organism is generally thought to be a virus or other infectious agent (as opposed to a bacterium) and to be spread in bodily secretions, especially blood and semen. It is responsible for the near-total collapse of the body's immune system, leaving the victim prey to cancers and opportunistic infections that the body is unable to defend against. And, while some of the diseases associated with AIDS can be successfully treated, the underlying immune problem is, apparently, irreversible. The AIDS patient may survive his first bizarre infection, or his second, but he remains vulnerable to successive infections, one of which is likely to kill him.

AIDS is deadly. According to the C.D.C.'s figures for late January, it has struck 958 individuals since it was first seen in 1979, and it has killed 365, a mortality rate of 38 percent; of the cases reported before June 1981, 75 percent are dead. Although these earlier cases probably received less experienced treatment than AIDS patients get today, some fear that the five-year death rate will be higher than 65 percent. Smallpox, by comparison, killed 25 percent of its victims.

According to Dr. James W. Curran, head of the AIDS task force at the C.D.C., ''The incidence of AIDS has nearly tripled in the past year, from about seven new cases a week to 20 or more.'' In December 1982, the center received reports of 92 cases of AIDS - about onethird more than had been received in any other single month.

As AIDS threatens to move into mainstream America, efforts to find its cause and stop its spread have intensified. In January, Congress allocated $2 million to the C.D.C. for AIDS research. Homosexual communities in major cities have set up support groups that provide information and guidance for victims and raise money for research. Hemophiliacs, many of whom depend on a clotting agent gathered from the blood of thousands of donors, have recently recommended that those at risk for AIDS be eliminated from the donor pool. Though the moral and legal implications of such screening have yet to be determined, blood suppliers are re-examining their procedures and the Department of Health and Human Services is working on proposals that would provide stricter screening of blood donors.

Meanwhile, AIDS continues on its mysterious and perplexing course. ''If Alfred Hitchcock were alive, he'd have his next movie,'' says Dr. Abe M. Macher, an infectious-disease specialist at the National Institutes of Health. ''When people discuss this syndrome at scientific meetings, it sounds like something out of 'The Andromeda Strain.' '' The search for the AIDS agent is being coordinated in Atlanta, at the Centers for Disease Control. There, 20 full-time physicians and other professionals (with help from 80 professionals working parttime) canvass the four corners of the outbreak - New York, PAGE 30 San Francisco, Los Angeles and Miami. They also keep track of the laboratory and clinical experiments being mounted not only at the C.D.C. but at research hospitals across the country. The job of these medical sleuths is complicated by the unusual nature of the patients. ecause the AIDS agent probably is transmitted both sexually and through blood, doctors must ask patients, and their survivors, intimate questions. ''It's the hardest part of this job,'' says Dr. Harold W. Jaffe, a member of the C.D.C. task force on AIDS. ''And I can understand people who don't cooperate. If I got a call from some guy who said, 'I'm with the C.D.C., and I want to know whether your brother was a homosexual,' I don't think I'd tell him anything.''

The job is complicated because the doctors know so little about the way many AIDS patients live. ''We know that our Haitian patients often are involved in voodoo and spiritualism,'' says Dr. Sheldon Landesman, assistant professor of medicine at the Downstate Medical Center in Brooklyn. ''But we don't know what in their rituals might be relevant to the transmission of AIDS.''

Drug users are equally elusive, and, says Dr. Gerald H. Friedland, an associate professor of medicine at the Albert Einstein College of Medicine in the Bronx, some of whose AIDS patients are addicts, ''getting good medical histories from them is very, very hard.''

Difficult though the task has been, however, the medical investigators have traced in broad outline the spread of the disease. In the spring of 1981, clinicians in New York City began to see a surprising number of cases of an extremely rare cancer called Kaposi's sarcoma. Dr. Linda J. Laubenstein, an instructor in clinical medicine at the New York University School of Medicine, recalls one of the first patients she saw with Kaposi's sarcoma. He was 33 years old and he arrived at the clinic with two purplish spots behind his ears. The patient responded well at first to anticancer drugs, but after 18 months his condition suddenly deteriorated, and he died with 75 lesions covering his body.

Kaposi's sarcoma is usually seen in this country in elderly men of Mediterranean extraction. In its classic form, Kaposi's sarcoma is treatable; its victims usually live at least 10 years after the condition is diagnosed and they often die of other causes.So when clinics in the city began to report severe cases of the rare sarcoma in young men, the medical community was alarmed. ''One patient was an interesting event,'' says Dr. Laubenstein; ''two was an epidemic.''

At about the same time, infectious-disease specialists throughout New York were noticing another bizarre occurrence. At the weekly citywide infectious-disease meetings sponsored by the New York City Department of Health, where physicians present their most perplexing cases, many of the cases mentioned involved a severe and potentially lethal form of pneumonia, Pneumocystis carinii.

Like Kaposi's sarcoma, Pneumocystis pneumonia was considered a rare disease. It also affected patients whose immune systems were severely compromised: cancer-chemotherapy patients and organ-transplant recipients.

Now, a new group of patients was developing the disease. ''Without even trying, we found 11 cases of Pneumocystis in young men,'' recalls Dr. Henry Masur, an infectious-disease expert then at New York Hospital-Cornell Medical Center and now at the National Institutes of Health. Within a year of diagnosis, eight of the 11 men were dead.

In mid-1981, the Federal Government became involved in the mystery. To investigate the outbreak, the C.D.C. formed a special task force, which published its first findings in June and July in Morbidity and Mortality Weekly Report, C.D.C.'s official publication. Of the 116 homosexual patients identified at the time, about 30 percent had Kaposi's sarcoma, about 50 percent had Pneumocystis pneumonia and about 10 percent had both. The remaining 10 percent had unusual infections that also usually affect only the immunosuppressed.

Half of the victims lived in New York City, and there was a large concentration of cases in California. Those studied were sexually promiscuous: Their average number of lifetime sexual contacts was 1,100; they frequented homosexual bars and bathhouses (where a typical visit may include sex with 15 to 20 deliberately anonymous men). Many of them also used ''poppers,'' inhalant amyl nitrite and butyl nitrite, drugs said to have the effect of enhancing orgasm.

In the fall of 1981, the C.D.C. studied the sexual habits of 50 homosexual victims of AIDS. The investigators did not ask for the names of their partners. ''We just didn't think they'd know any names,'' admits Dr. Darrow, a member of the C.D.C. task force who has spent 20 years studying the spread of sexually transmitted diseases. Later, to his surprise, some people came forward on their own to volunteer names.

''One guy in Los Angeles whose dear friend had died - a man with whom he had lived for many years - came to us and said, 'You really ought to know that my friend had sex with three or four of the other cases in Los Angeles and six more cases I know of throughout the United States,' '' Dr. Darrow says. ''Simultaneously, a patient who had been seen for syphilis told us, 'I had sex with five or six people I know of who have the gay plague.' That made us think that maybe the others would know the names of some of their contacts.''

For 13 patients in Los Angeles, Dr. Darrow and Dr. David Auerbach, a C.D.C. officer based in the city, compiled a list of all the sex partners that the patients or their survivors could name for the previous five years. They then compared those names with the roster of all the cases in the country. The result: Of those 13 cases, nine had sex contacts in common, a finding that could not possibly have been a random coincidence. This was the so-called L.A. cluster of AIDS patients. Later, a missing link was found between Los Angeles and New York. An AIDS patient from New York was identified as having been a sexual partner of four men in the L.A. clus- AIDS JUMP Pg32 ter - as well as of four other men in New York who also developed AIDS.

Epidemiologists developed many theories about why homosexual men were at risk for these rare infections and cancers. Sexually active homosexuals are prone to a host of diseases: syphilis, gonorrhea, genital herpes, hepatitis, amebiasis (one of the most common diseases in what doctors call the ''gay bowel syndrome'') and infections caused by fungi and protozoa usually seen only in the tropics. Indeed, bizarre infections are so common in the homosexual community that one scientist, presenting a report on these occurrences in 1968, called his talk ''Manhattan: The Tropical Isle.''

One theory was that the immune systems of the patients were being crippled after repeated infection by these sexually transmitted diseases. Other theories were that a new virus that could destroy immunity was being transmitted through oral-anal or anogenital contact; or that the amoeba responsible for amebiasis was carrying with it a previously unknown virus; or that overexposure to sperm from many sources was having an immune-suppressant effect (in animals, sperm in the bloodstream is known to suppress the immune system); or that poppers were damaging the immune system (another theory that had some basis in animal research).

As the syndrome spread to other groups, however, early theories that attempted to explain the outbreak among homosexuals were discarded. Within months, intravenous-drug users - both men and women - who were not homosexuals were showing the same signs of immune suppression and developing the same unusual opportunistic infections. Then came Haitians, in both the United States and Haiti, who said they were neither homosexuals nor drug users but who developed what appeared to be an identical syndrome of acquired immune deficiency.

The Haitian connection was made almost by a fluke. An epidemiologist working for the C.D.C. on another matter had trained in Haiti and returned there on vacation. He mentioned to a former colleague the odd infections that were turning up among Haitians in Miami. To his astonishment, the Haitian dermatologist replied that he, too, had seen several cases of Kaposi's sarcoma. Since then, teams of physicians from the C.D.C. and from the University of Miami, where many Haitian immigrants with AIDS are treated, have visited Haiti in an attempt to confirm that it really is the same syndrome and to determine if the agent originated in the Caribbean and moved north or whether it was transported to Haiti from this country.

In the spring of 1982, the C.D.C. received its first reports of AIDS in hemophiliacs. Some of these patients were probably exposed to the AIDS agent in a blood-clotting medication called factor VIII concentrate that is made from the blood of thousands of donors. Anywhere from 2,500 to 22,000 blood donors are used to make just one lot of this widely used product; one lot treats about 100 patients. To date, the C.D.C. has received a total of eight confirmed reports of hemophiliacs with AIDS, six of whom have died. All used factor VIII concentrate rather than an older, less convenient blood product called cryoprecipitate, which is made from the blood of a handful of donors. In view of the AIDS threat, some hemophilia experts are urging a return to cryoprecipitate, especially in mild or newly diagnosed cases.

In the summer of 1982, the C.D.C. received reports of three patients who contracted AIDS after receiving blood transfusions. Two of those patients were adults from the Northeast and the third was an infant in San Francisco who needed a transfusion to correct an Rhfactor incompatibility. Four more cases of possible transmission of AIDS through blood transfusions are now being investigated.

By mid-January, the C.D.C. had received five reports of AIDS that had spread to female sexual partners of drug abusers. In four of those cases, the male partners had not even been sick. Thus, AIDS qualified as a sexually transmitted disease among heterosexuals. It also began to be clear that individuals could be identified who might be carriers of the AIDS agent, able to infect other people without themselves developing symptoms.

As of mid-January, the C.D.C. had also heard of 26 infants and young children with symptoms of AIDS. Thirteen of these children had opportunistic infections, indicating that they probably had AIDS; the 13 others had AIDS-like immune deficiencies, but no serious infections. Of the 13 children with infections, nine have since died. Many of the children are in foster care, and the C.D.C is trying to trace their mothers and take Page 36 medical histories. The cases were found in New York, New Jersey and San Francisco. As far as the Federal agents could tell, most of the children were born to mothers with acquired immune deficiency syndrome, or at least to mothers at risk for the syndrome because of drug use. Dr. James Oleske, a pediatric immunologist and associate professor at the University of Medicine and Dentistry of New Jersey, has treated eight young patients since 1979, four of whom have died. He believes the disease is passed on either in the womb or through normal contact between mother and child after birth. ''It's a tragedy,'' he says of the cases he has seen. ''The only thing to be said for it is that eventually AIDS will help us understand more about the immune system.'' Homosexual men still represent 75 percent of the disease's victims, and the specter of AIDS haunts every member of the homosexual community, especially in the cities where it is most prevalent (they are, in descending order, New York, San Francisco, Los Angeles, Miami, Newark, Houston, Chicago, Boston, Washington and Philadelphia).

''You don't know what it's like to be gay and living in New York,'' says Larry Kramer, 47, a novelist and screen writer and the cofounder of Gay Men's Health Crisis, an educational and fund-raising group for AIDS victims. ''It's like being in wartime. We don't know when the bomb is going to fall. I've had 18 friends die in the last year and a half from AIDS,'' Mr. Kramer says. ''Another 12 are now seriously ill, and six of them are in the hospital. Doctors and psychiatrists are pleading with the community to learn a new way of socializing. They're begging us, in the name of all who died, to learn how to date.''

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And, in fact, behavioral changes are currently the only prudent advice physicians can offer. Some doctors hesitate to urge celibacy or monogamy on patients for whom casual sex is a way of life, but most seem to think the evidence is compelling enough to advocate just that. ''I strongly recommend that my patients be very circumspect and cautious in their future sexual contacts,'' says Dr. Dan William, a Manhattan internist who treats primarily homosexual men. In his practice of some 2,000 patients, he has seen 24 cases of AIDS.

''I tell my patients what the epidemiologists know -which isn't much,'' says Dr. William. ''We are more or less convinced that we are dealing with a sexually transmissible agent. Large numbers of contacts - or a small number of indiscriminate contacts - increase the probability of exposure. In addition, a patient's susceptibility to any infectious disease is much greater.'' Dr. William counsels monogamy, and, he adds, ''It's important for a patient to emphasize to his sex contact that he must not bring any new diseases home with him.''

Many doctors go even further. They urge patients to eliminate anal intercourse, which frequently results in bleeding or trauma to the mucosal lining and is a possible source of AIDS transmission. They advise their homosexual patients to use condoms, which are thought to inhibit the spread of similarly transmitted diseases such as hepatitis B. And a few urge their patients to eliminate sex altogether. The groups most recently found to be at risk for AIDS present a particularly poignant problem. Innocent bystanders caught in the path of a new disease, they can make no behavioral decisions to minimize their risk: Hemophiliacs cannot stop taking blood-clotting medication; surgery patients cannot stop getting transfusions; women cannot control the drug habits of their mates; babies cannot choose their mothers.

One way to try to stop the syndrome from spreading further is to keep the AIDS agent out of the nation's blood supply, if, indeed, a blood-borne virus is the culprit. Even that is still uncertain. ''It's not clear at all that there's a new blood-borne virus involved,'' says Dr. David Aronson, director of the coagulation branch of the division of blood and blood products of the Food and Drug Administration. ''I can't see anything different in the death patterns of hemophiliacs now from four years ago.'' As early as 1979, he says, five to 10 hemophiliacs a year were dying of unusual infections and cancers that today would be called AIDS, although the disease had not yet been identified. He theorizes that anticlotting medication itself might have an immune-suppressant effect. Dr. Aronson thinks the AIDS threat to hemophiliacs has been overstated. ''It's more of a threat to try to change their treatment without thinking things through,'' he says.

Some other experts caution against unnecessary alarm. ''I'm concerned and worried,'' says Dr. Joseph Bove, chairman of the American Association of Blood Banks committee on transfusion-transmitted diseases and a professor of laboratory medicine at the Yale University School of Medicine. ''But as a scientist, I have to look at the evidence. And the evidence is that ordinary blood transfusions are not transmitting AIDS.'' In the two years since AIDS was first identified, Dr. Bove says, ''20 million people have been transfused, and some must have gotten blood from donors with AIDS. But we don't see an epidemic of AIDS spread by blood.'' Dr. Bove contends that a number of AIDS patients in San Francisco have been identified as blood donors, and to date, the only confirmed case of transfusionrelated AIDS there occurred in the baby who received an Rh transfusion.

''What Dr. Bove is not taking into account is the incubation period of AIDS,'' says Dr. Bruce L. Evatt, director of the division of host factors at the C.D.C. Although the risk now appears to be less than one AIDS case per million transfusions, he says, it may increase significantly.

The Department of Health and Human Services is issuing broad recommendations to reduce the risk of AIDS transmission. Mentioned prominently are feasibility studies for a ''surrogate marker'' to eliminate donors who belong to groups at risk for AIDS. This marker would provide indirect laboratory evidence of membership in an AIDS risk group. For example, over half of the four groups at risk for AIDS -homosexuals, Haitians, intravenous-drug users and hemophiliacs - have antibodies in their blood streams that indicate they have been exposed to hepatitis B. By contrast, hepatitis B antibodies appear in just 5 percent of the general blood-donating population. Currently, donors' blood is tested for syphilis and hepatitis B antigens, which indicate the presence of infection. (The presence of antibodies suggests only that the person has been exposed to the disease, not that his blood is infected.) A blood test for hepatitis B antibodies, then, might screen out many of those at high risk for AIDS.

Government experts say it would be imprudent to delay sounding an alarm until the AIDS agent is found. ''If we wait around until we prove it is an infectious agent, it may be a year, it may be two years,'' Dr. Evatt says. ''In the meantime, our one thousand cases could grow to two, AIDS 2d JUMP PAGE 38 three or four thousand.'' Risk-reduction efforts today are based on educated hunches, he admits, ''but the quicker you institute changes, the more lives you can save, if you guessed right.''

Meanwhile, unofficially, homosexual men are being asked emphatically not to donate blood. Some experts encourage the use of ''autologous'' transfusions whenever possible; blood is taken from the patient before an operation and re-infused in him during surgery as needed. And hemophiliacs and those who treat them are faced with difficult decisions about the mode of treatment to follow. Cryoprecipitate, while currently not implicated in the spread of AIDS, probably does not assure safety either. Each dose of cryoprecipitate is made from the blood of 15 to 20 donors; eventually, then, even this form of therapy probably would carry some risk. Though the C.D.C. now defines AIDS as the occurrence of Kaposi's sarcoma in men under 60 or opportunistic infection in people who had not had diseases or therapies known to be immunosuppressive, the first signs of the disease can be so innocuous they might be overlooked: swollen glands, low-grade fever, weight loss and a general feeling of malaise, symptoms similar to those of many other diseases. Sometimes the patient is troubled by a common infection that he cannot shake - most typically, shingles or oral thrush (a fungal infection of the mouth and throat). Diarrhea or abdominal cramps may also occur.

Because AIDS can begin so benignly, homosexual men in apparent good health are flocking to clinics and doctors' offices to see whether they have a hidden case of AIDS.

The only thing that appears to be clear about the disease is that it is the result of an imbalance of white blood cells called T lymphocytes that are responsible for fighting off infection. There are two types of T cells: helper cells, which help other immune cells ferret out and eliminate foreign organisms, and suppressor cells, which inhibit this activity. Healthy individuals have twice as many helper cells as suppressor cells. In AIDS patients, the T-cell ratio is reversed.

While immune-function tests that measure of ratio of T cells are available, most doctors and clinicians advise people at risk for AIDS against having them. The tests are expensive, ranging from $100 to $600, and the results are virtually impossible to interpret with any accuracy.

Many people show signs of ''lymphadenopathy syndrome'' - they have chronically swollen glands and damaged immune function. Doctors do not know if this is a passing condition, a mild form of AIDS or a harbinger of worse to come. All they know is that immune abnormalities have been found in as many as 80 percent of the homosexual men in New York City whose T-cell ratios were measured, even though most of them were apparently healthy. But no one ever looked for immune-function problems in these individuals before, so it is not clear what the findings mean. Investi-gators have embarked on some longterm studies to follow what happens to these men. Doctors are both fascinated and appalled by AIDS. Young physicians specializing in infectious diseases see the syndrome, rightly, as a fertile area for research and publication, a chance to make their names in the always competitive circles of academic medicine. Epidemiologists, too, feel their adrenaline rise in the rush to solve the deadly mystery. ''We epidemiologists thrive on epidemics,'' the C.D.C.'s Dr. Curran told a meeting of the American Society for Microbiology last October. ''We never admit that we love them, but they are the lifeblood that motivates us. This epidemic has been very different. It has lasted too long, and too many have died.''

Indeed, physicians must watch in frustration as their young patients die; there is little to be done to save them. ''During two weeks in September, we had seven new patients,'' says Dr. Chester W. Lerner, at Lenox Hill Hospital in New York. ''All isolation beds in the intensive-care unit were filled with gay men with AIDS.'' Two of them did not live until the end of the year.

As they waste away, many AIDS patients begin to reflect on their lives, sometimes feeling they are being punished for their reckless, hedonistic ways.

''It's like the old one-two whammy,'' says Dr. Dan William. ''A diagnosis of cancer or some other terminal disease is heavy enough. But add to that the fact that the patients are young, most of them in their 20's and early 30's. Then tell the patients that this disease that may kill them while they are young is due to their sexual behavior. Then tell them that it is due to their gay sexual behavior. And then tell them that it may be infectious. You're going to create all kinds of feelings in these young men - and none of them are pleasant.''

According to Dr. William, AIDS patients express guilt, anger, remorse, depression and despair. ''And there's fear, too,'' he says, ''especially fear of desertion. They are terrified that their fate will be like the fate of another group of diseased individuals - lepers.''

Chuck, a 42-year-old homosexual with Pneumocystis pneumonia, says he feels neither guilt nor fear. ''Many people I know of with this disease, their lives are just shattered,'' he says from his hospital bed at the National Institutes of Health in Bethesda, Md. ''They never go out; they're depressed and they blame themselves for being sick. I've never felt that way.''

Chuck has been hospitalized twice since his Pneumocystis was diagnosed in December 1981. Yet, he has continued to have sex with strangers and admits to encounters with dozens of men, both at home and while he was vacationing in Europe. He is considerably less active now, he says: ''If I meet somebody I'm attracted to, I'm not as apt as I used to be to say, 'Yes, let's go.' But I don't know if that's the disease - maybe in the back of my mind I think I could contract something again - or if it's that I'm getting older.'' He does not tell AIDS JUMP 3rd Jump his sexual contacts that he has AIDS and seems genuinely surprised by the suggestion that he might tell them. ''I wonder what would happen if I did,'' he muses.

While Chuck maintains that his life has gone on basically as before, Juan, with a record of drug use, says AIDS has turned his life upside down. ''I'm what you would call a late bloomer,'' says Juan, 32, who has returned to the Montefiore Medical Center for his second hospitalization for Pneumocystis pneumonia. ''Life was just starting to be less complicated.'' He recently got his first goodpaying job, and he had been cutting ties with the heroin-using crowd he grew up with. (Juan, who says he was never addicted, was a weekend user of intravenous heroin and cocaine for much of his adult life, and he shared needles with at least one man who was later hospitalized with AIDS.)

''And then this happened,'' he says, more incredulous than bitter. ''I can't work - I tried to when I came out of the hospital last spring, but after a week on the job I began to have trouble breathing again. So then I had to spend all my time running around, trying to get unemployment and disability. I think that's why I got sick again, from all that running around.'' His wife, distraught over the uncertainty of the outcome of the disease, left him.

Juan was once a stocky man with a macho swagger. But he has lost more than 30 pounds in the last six months, and now he looks lean and vulnerable. He has done a lot of soul-searching in his hospital room. ''I can empathize now with terminal cancer patients; I know how they must feel,'' he says. Doctors all over the country are experimenting with treatments for AIDS; they have found that many of the infections, and even Kaposi's sarcoma, respond to medication up to a point. Pneumocystis pneumonia, for instance, can be treated with pentamidine, a drug that must be provided through the C.D.C. And at several medical centers, scientists are treating Kaposi's sarcoma with some success. At N.Y.U., 90 percent of treated patients have responded to VP16-213 Etoposide, an experimental drug developed to treat leukemia and lymphoma.

At Memorial Sloan-Kettering Cancer Center, Kaposi's sarcoma is being treated with the antiviral substance interferon. ''We were looking for an agent that might fight cancer, that might improve the immune system and that might have an antiviral effect,'' explains Dr. Bijan Safai, chief of the dermatology service at Sloan-Kettering. Interferon, a natural product of white blood cells that has been effective against certain cancers and viruses, had a good chance of doing all three. Dr. Safai has seen more than 70 patients with Kaposi's sarcoma; 30 of them have received interferon. Of the 12 who completed the treatment before February 1982, three have no evidence of cancer and their immune function is improved; three have showed partial response; and six have showed no response. The remaining 18 have not completed their course of treatment.

Interferon might also be useful in the treatment of AIDS itself. Dr. Michael S. Gottlieb, an assistant professor of medicine at the University of California at Los Angeles School of Medicine, is collaborating with Dr. Frederick P. Siegal of Mount Sinai Medical Center in New York in a controlled trial of interferon in early AIDS.

Other efforts have also been made to reverse the underlying abnormality of AIDS. Dr. Siegal has tried bone-marrow transplants; Dr. Masur of the National Institutes of Health is using interferon and working with another byproduct of white blood cells called interleukin 2; Dr. Michael H. Grieco of St. Luke's-Roosevelt Hospital is experimenting with different immune-stimulating drugs. The results are still being studied. But so far, it seems that the immune-system abnormalities of AIDS are almost always irreversible - at least by the time they are detected. The search for a cause for acquired immune deficiency is leading scientists in several directions at once. Researchers are particularly interested in two viruses, both of them related to the herpes virus: cytomegalovirus (CMV) and Epstein-Barr virus. CMV, which causes mental and motor retardation in children infected before birth, has been known to suppress the immune system in mice. In addition, CMV antibodies were found in 80 to 95 percent of AIDS patients, compared with 50 percent in the general population. Antibodies for Epstein-Barr virus, which causes infectious mononucleosis, were also found in extremely high concentrations in AIDS patients. ''It was very striking,'' says Dr. Ilya Spigland, chief of the virology division at Montefiore Medical Center in the Bronx. Patients with AIDS sometimes show Epstein-Barr antibody levels ''10-fold to 100-fold higher than normal,'' he says. Dr. Spigland runs one of the city's most comprehensive virology laboratories and has performed the lab work for most of the AIDS research that has been published. ''It's terribly difficult,'' he says. ''When you try to isolate a virus, you need to know the characteristics of that particular virus, so you know how to treat the blood sample -whether to refrigerate it or freeze it, for example. But with this organism, we don't know what we're looking for, so we don't know how to try to protect it.'' Dr. Spigland is among those who place great stock in the Epstein-Barr connection, either as a primary cause of the immune deficiency or, more likely, as a second step following some still-unknown event that eventually leads to immunological breakdown.

Other investigators are following groups of apparently healthy patients with certain immunological abnormalities to see who among them develop opportunistic infections or other more obvious symptoms of AIDS. Dr. Grieco and Dr. Michael Lange, an infectious-disease specialist at St. Luke's-Roosevelt Hospital Center in New York, are studying 81 homosexual males chosen at random; more than 80 percent of them show signs of altered T cells. Dr. Landesman at Downstate Medical Center is following all Haitian patients who come to the hospital with tuberculosis; based on Dr. Landesman's past experience, approximately 10 percent of them can be expected to go on to develop acquired immune deficiency.

Even after the agent is found, the spread of AIDS might still be impossible to stop. Like hepatitis B, a viral disease that can be sexually transmitted, the AIDS agent probably can be harbored for months before it causes problems. The incubation period for AIDS is thought to be at least six to eight months and could be as long as two years. This means that people who have already been infected might not know it until sometime between mid-1983 and the end of 1984. By then, each carrier might have unknowingly infected hundreds more individuals - through sexual contact, through blood donations, or through some yet unimagined route.

''Most epidemics behave better than this,'' says the C.D.C.'s Dr. Curran. ''Like detective stories, they come eventually to a merciful end - even if they remain unsolved.'' But with acquired immune deficiency, more than two years after the first case was reported, there is still no end in sight.

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A version of this article appears in print on February 6, 1983, on Page 6006028 of the National edition with the headline: AIDS A NEW DISEASE'S DEADLY ODYSSEY. Today's Paper|Subscribe